Hospitals decide how much to bill Medicare for your care based on your diagnostic-related group (DRG). They then charge Medicare based on your DRG tier instead of separately for each of your medical ...

A key objective is to enable updates to the MS-DRG payment rates that are no longer dependent on gross charges billed by hospitals that are reduced to cost using hospitals' cost report data. Included ...

In 2004, the Centers for Medicare and Medicaid Services instituted a "one-way edit protocol" for transfer diagnosis-related groups. While CMS identifies and recovers any overpayments, it does not ...

Sens. Chuck Grassley (R-IA) and Max Baucus (D-MT) are asking CMS to delay planned changes to Medicare payments. In April, CMS proposed changes to the diagnostic-related groups (DRGs), the system used ...

The HHS Office of Inspector General has issued a report recommending CMS expand the DRG window. The DRG window was created in 2011. The policy essentially says that outpatient services related to an ...

A recent HHS Office of Inspector General (OIG) report examines Medicare services provided during the Medicare Severity Diagnosis Related Group (DRG) payment window – that is, the period when certain ...

There are many ways that hospitals can lose money these days, including during patient discharge. The planning and documentation for those discharges can be very complex. That’s especially the case ...

San Diego, CA - The Centers for Medicare and Medicaid Services (CMS) held a conference call yesterday to discuss the recently approved recovery auditor contractor prepayment review that is going into ...

Diagnostic-related groups (DRGs) are how Medicare and some other health insurance companies categorize hospital costs to determine how much to pay for a hospital stay. With DRGs, the payment amount ...